Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
JU INSIGHT Testicular Biopsy Timing Relative to Oocyte Retrieval and Intracytoplasmic Sperm Injection Outcomes
By: Lily Ng, BSc, The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York; Olena M. Kocur, BA, The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York; Philip Xie, BSc, The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York; Stephanie Cheung, MSc, The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York; Peter Schlegel, MD, Weill Cornell Medicine, New York, New York; Zev Rosenwaks, MD, The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York; Gianpiero D. Palermo, MD, PhD, The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York | Posted on: 20 May 2024
Ng L, Kocur OM, Xie P, et al. Timing of testicular biopsy in relation to oocyte retrieval and the outcomes of intracytoplasmic sperm injection. J Urol. 2024;211(5):678-686. doi:10.1097/JU.0000000000003894
Study Need and Importance
This study addresses the long-debated question of the optimal timing to perform testicular biopsy by microscopic testicular sperm extraction (micro-TESE), whether performed on the same day (day of) or antecedent to (day before) oocyte retrieval, in couples where the male partner has nonobstructive azoospermia. The rationale for retrieval on the day before would be to have a better backup plan for the oocyte retrieval and/or cryopreservation in case of failed sperm retrieval. In addition, it has been proposed that an overnight incubation may be beneficial to enhance testicular sperm motility. Our finding is that there is no difference in micro-TESE timing; therefore, the study represents an important contribution to help reproductive physicians and their couples to choose the time of testicular biopsy solely on logistic reasons.
What We Found
The study identified somewhat higher sperm retrieval (69% vs 62%) and fertilization (53% vs 45%) rates in the TESE day of group, albeit there was no difference in clinical pregnancies (43% vs 45%) and deliveries (43% vs 42%; Table). This similarity was confirmed in subanalyses consisting of men with Klinefelter syndrome, couples using supernumerary frozen embryos in subsequent cycles, or men who underwent a repeated testicular biopsy.
Limitations
A limitation of this study may be identified in its retrospective nature and that it has been carried out in a single reproductive center by a single urology surgeon.
Interpretation for Patient Care
The study suggests that micro-TESE can be comfortably performed on the day of or day before oocyte retrieval. The decision to allocate to TESE day before can be driven solely by the logistics related to time and personnel for adequate specimen processing and in relation to scheduling preference by the physician and/or patient.
Table. Overall Clinical Outcome of Testicular Sperm Extraction–Day-Before and –Day-Of Cohorts With Fresh Embryo Transfer (by Decade)
| 1993-2002 | 2003-2012 | 2012-Present | P valuea | ||||
|---|---|---|---|---|---|---|---|
| Day-before TESE | Day-of TESE | Day-before TESE | Day-of TESE | Day-before TESE | Day-of TESE | ||
| No. cycles | 7 | 103 | 102 | 169 | 184 | 73 | |
| Fertilization, No. (%) | 42 (50) | 620 (60) | 766 (53) | 1030 (56) | 1361 (44) | 406 (53) | .2 |
| Day 3 transfers, No. (%) | 7 (100) | 87 (85) | 85 (83) | 160 (95) | 148 (80) | 61 (84) | |
| +β-hCG, No. (%) | 4 (57) | 60 (58) | 62 (61) | 98 (58) | 95 (52) | 35 (48) | .2 |
| Embryo implantation, No. (%) | 7 (39) | 57 (18) | 69 (29) | 96 (25) | 84 (27) | 32 (22) | .2 |
| Clinical pregnancies (+FHB), No. (%) | 4 (57) | 48 (47) | 55 (54) | 74 (44) | 74 (40) | 29 (40) | .8 |
| Delivery/ongoing, No. (%) | 3 (43) | 43 (42) | 51 (50) | 70 (41) | 70 (38) | 28 (38) | .2 |
| Abbreviations: +, positive; FHB, fetal heartbeat; hCG, human chorionic gonadotropin; TESE, testicular sperm extraction. aSpearman’s rank correlation, effect of eventual practice shifts over time on clinical outcome. There was no evidence observed that any shifts in clinical practice over the years influenced the clinical outcome. |
|||||||
advertisement
advertisement